Proposition 44State law · Citizen initiative
Clinic mission-spending requirement
Explain it like I'm 5
Certain community health clinics would have to spend at least 90 cents of every dollar on work related to their mission. That includes more than doctor visits, like services that help the clinic care for patients.
Yes vote
Covered federally qualified health centers and related organizations would have to spend at least 90% of annual revenue on mission-related purposes.
No vote
The proposed 90% mission-spending requirement would not take effect.
The question to ask yourself
Would a fixed 90% floor improve accountability more than it would reduce clinics’ flexibility?
The case for
- A clear minimum could reassure the public that clinic money is focused on the clinics’ purpose.
- Supporters say it could reduce waste and increase accountability.
- Mission-related spending can include services beyond direct patient visits.
Backed by: SEIU United Healthcare Workers West, Californians for Responsible Healthcare
The case against
- A fixed percentage may not fit clinics with different rent, staffing, technology, and compliance needs.
- Penalties or fees could weaken clinics that already serve underserved communities.
- Disputes over what counts as mission-related spending could add administrative work.
Opposed by: American Academy of Pediatrics California, California School Nurses Organization, California Academy of Family Physicians, California Medical Association
- Money
- The state estimates increased costs in the low tens of millions of dollars annually, funded through fees on affected clinics. [Official guide](https://voterguide.sos.ca.gov/propositions/44/)
- Don't be misled
- It is misleading to say 90% must be spent only on doctor visits because the rule concerns broader mission-related purposes.